Basic Information
| Provider Information | |||||||||
| NPI: | 1750375929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHOZLAND | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11645 WILSHIRE BLVD STE 905 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103939359 | ||||||||
| FaxNumber: | 3104517807 | ||||||||
| Practice Location | |||||||||
| Address1: | 11645 WILSHIRE BLVD STE 905 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103939359 | ||||||||
| FaxNumber: | 3104517807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A86726 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00A867260 | 05 | CA | MEDICAID |